SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| 330 HUDSON STREET, 13TH FLOOR |
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(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
01/30/2023
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3. Issuer Name and Ticker or Trading Symbol
AdTheorent Holding Company, Inc.
[ ADTH ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
| Chief Financial Officer |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
|
| No securities are beneficially owned. |
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/s/ Thomas P./ Conaghan, Attorney-in-Fact |
01/30/2023 |
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** Signature of Reporting Person |
Date |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
| * If the form is filed by more than one reporting person,
see
Instruction
5
(b)(v). |
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS, that I, Patrick Elliott, hereby
constitute and appoint Daniel L. Woodard, Brandon Sloane, Charles Darantiere
and Thomas P. Conaghan, and each of them, my true and lawful attorneys-in-fact
and agents, with full power of substitution and resubstitution for me and in my
name, place and stead, to sign any Form ID (Uniform Application for Access
Codes to File on EDGAR), reports on Form 3 (Initial Statement of Beneficial
Ownership of Securities), Form 4 (Statement of Changes in Beneficial Ownership
of Securities) and Form 5 (Annual Statement of Beneficial Ownership of
Securities) relating to transactions by me in shares of Common Stock or other
securities of AdTheorent Holding Company, Inc. and all amendments thereto, and
to file the same, with the Securities and Exchange Commission and the
appropriate securities exchange, granting unto said attorneys-in-fact and
agents, and each of them, or their substitutes, full power and authority to do
and perform each and every act and thing requisite or necessary to be done in
and about the premises, as fully to all intents and purposes as I might or
could do in person, hereby ratifying and confirming all that said attorneys-in-
fact and agents, and each of them, or their substitutes, may lawfully do or
cause to be done by virtue hereof. This Power of Attorney shall be effective
until such time as I deliver a written revocation thereof to the above-named
attorneys-in-fact and agents.
Dated: January 19, 2023 /s/ Patrick Elliott
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Patrick Elliott
